成人会厌炎的插管决策标准。

Intubation decision criteria in adult epiglottitis.

作者信息

Pineau P M, Gautier J, Pineau A, Emam N, Laccourreye L, Boucher S

机构信息

Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire d'Angers, 4, Rue Larrey, 49100 Angers, France.

Pôle "Neurosciences, Vieillissement, Médecine et Société", Centre de Recherche sur l'Autonomie et la Longévité (CeRAL), Service de Gériatrie, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100 Angers, France.

出版信息

Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Oct;138(5):329-332. doi: 10.1016/j.anorl.2020.12.001. Epub 2020 Dec 24.

DOI:10.1016/j.anorl.2020.12.001

PMID:33358682

Abstract

OBJECTIVES

To identify contributive criteria in decision-making for intubation in acute epiglottitis, based on clinical and endoscopic data in adult patients, and to study clinical and biological characteristics and management.

MATERIALS AND METHODS

Diagnosis was established by flexible endoscopy showing epiglottic edema in association with general signs of sepsis in 28 patients consulting into two French hospitals between 2005 and 2016. Retrospective univariate and multivariate analysis between patients managed by intubation (Group I) or surveillance (Group S) was performed on clinical and endoscopic data.

RESULTS

Ten patients were intubated (36%). On univariate analysis, 4 variables were suggestively associated with intubation. On multivariate analysis, associations remained suggestive for dyspnea (OR=50.6; 95% CI=[2.7; 940.1]) and supraglottic edema extension (OR=42.2; 95% CI=[2.2; 799.5]). The area under the curve identifying intubated patients on these 2 criteria was 90.8%, testifying to high discrimination.

CONCLUSION

Intubation must always be considered in epiglottitis. Dyspnea and supraglottic extension of the edema seem to be the two main criteria to be considered in airway control decision-making.

摘要

目的

基于成年患者的临床和内镜数据，确定急性会厌炎插管决策中的相关标准，并研究临床和生物学特征及治疗方法。

材料与方法

2005年至2016年间，在两家法国医院就诊的28例患者经软性内镜检查显示会厌水肿并伴有脓毒症的一般体征，从而确诊。对插管治疗的患者（I组）和接受监测的患者（S组）的临床和内镜数据进行回顾性单因素和多因素分析。

结果

10例患者接受了插管治疗（36%）。单因素分析显示，4个变量与插管治疗有提示性关联。多因素分析显示，呼吸困难（比值比[OR]=50.6；95%置信区间[CI]=[2.7；940.1]）和声门上水肿范围（OR=42.2；95% CI=[2.2；799.5]）与插管治疗仍有提示性关联。根据这两个标准识别插管患者的曲线下面积为90.8%，证明具有较高的区分度。